Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection

Michael L. Grover, Jesse D. Bracamonte, Anup K. Kanodia, Michael Bryan, Sean P. Donahue, Anne Marie Warner, Frederick D. Edwards, Amy L. Weaver

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined. RESULTS: Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coli was sensitive to SMX-TMP in 33 (34%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients. CONCLUSION: Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.

Original languageEnglish (US)
Pages (from-to)181-185
Number of pages5
JournalMayo Clinic Proceedings
Volume82
Issue number2
DOIs
StatePublished - 2007

Fingerprint

Urinary Tract Infections
Guidelines
Urine
Sulfamethoxazole Drug Combination Trimethoprim
Anti-Bacterial Agents
Documentation
Prescriptions
Outpatients
Medicine
Physicians
Therapeutics
International Classification of Diseases
Ciprofloxacin
Internship and Residency
Sexually Transmitted Diseases
Medical Records
Inpatients
History
Escherichia coli

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Grover, M. L., Bracamonte, J. D., Kanodia, A. K., Bryan, M., Donahue, S. P., Warner, A. M., ... Weaver, A. L. (2007). Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. Mayo Clinic Proceedings, 82(2), 181-185. https://doi.org/10.4065/82.2.181

Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. / Grover, Michael L.; Bracamonte, Jesse D.; Kanodia, Anup K.; Bryan, Michael; Donahue, Sean P.; Warner, Anne Marie; Edwards, Frederick D.; Weaver, Amy L.

In: Mayo Clinic Proceedings, Vol. 82, No. 2, 2007, p. 181-185.

Research output: Contribution to journalArticle

Grover, ML, Bracamonte, JD, Kanodia, AK, Bryan, M, Donahue, SP, Warner, AM, Edwards, FD & Weaver, AL 2007, 'Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection', Mayo Clinic Proceedings, vol. 82, no. 2, pp. 181-185. https://doi.org/10.4065/82.2.181
Grover, Michael L. ; Bracamonte, Jesse D. ; Kanodia, Anup K. ; Bryan, Michael ; Donahue, Sean P. ; Warner, Anne Marie ; Edwards, Frederick D. ; Weaver, Amy L. / Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection. In: Mayo Clinic Proceedings. 2007 ; Vol. 82, No. 2. pp. 181-185.
@article{8b8da3d4c6d4465795d052ed6a00639c,
title = "Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection",
abstract = "OBJECTIVE: To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined. RESULTS: Of 228 patients, 68 (30{\%}) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84{\%}) and 52 (76{\%}) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38{\%}). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coli was sensitive to SMX-TMP in 33 (34{\%}) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients. CONCLUSION: Only 30{\%} of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25{\%} received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.",
author = "Grover, {Michael L.} and Bracamonte, {Jesse D.} and Kanodia, {Anup K.} and Michael Bryan and Donahue, {Sean P.} and Warner, {Anne Marie} and Edwards, {Frederick D.} and Weaver, {Amy L.}",
year = "2007",
doi = "10.4065/82.2.181",
language = "English (US)",
volume = "82",
pages = "181--185",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "2",

}

TY - JOUR

T1 - Assessing adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection

AU - Grover, Michael L.

AU - Bracamonte, Jesse D.

AU - Kanodia, Anup K.

AU - Bryan, Michael

AU - Donahue, Sean P.

AU - Warner, Anne Marie

AU - Edwards, Frederick D.

AU - Weaver, Amy L.

PY - 2007

Y1 - 2007

N2 - OBJECTIVE: To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined. RESULTS: Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coli was sensitive to SMX-TMP in 33 (34%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients. CONCLUSION: Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.

AB - OBJECTIVE: To assess adherence to evidence-based guidelines for the diagnosis and management of uncomplicated urinary tract infection (UTI) in a family medicine residency clinic setting. PATIENTS AND METHODS: We retrospectively reviewed the medical records of female patients seen in 2005 at the Mayo Clinic Family Medicine Center in Scottsdale, Ariz, who were identified by International Classification of Diseases, Ninth Revision code 599.0 (UTI). We assessed documentation rates, use of diagnostic studies, and antibiotic treatments. Antibiotic sensitivity patterns from outpatient urine culture and sensitivity analyses were determined. RESULTS: Of 228 patients, 68 (30%) had uncomplicated UTI. Our physicians recorded essential history and examination findings for most patients. Documentation of the risk of sexually transmitted disease differed between residents and attending physicians and was affected by patient age. Urine dipstick and urine culture and sensitivity analyses were ordered in 57 (84%) and 52 (76%) patients, respectively. Eighty percent of patients with positive results on urine dipstick analyses also had urine culture and sensitivity analyses. Sulfamethoxazole-trimethoprim (SMX-TMP) was used as initial therapy in 26 patients (38%). Sixty-one percent of SMX-TMP and ciprofloxacin prescriptions were appropriately provided for 3 days. Escherichia coli was sensitive to SMX-TMP in 33 (34%) of 35 cultures. Treatment was not changed in any patient with an uncomplicated UTI because of results of urine culture and sensitivity analyses. Antibiotic sensitivity patterns for outpatients were significantly different from those for inpatients. CONCLUSION: Only 30% of our patients had uncomplicated UTI, making their management within clinical guidelines appropriate. However, of those patients with uncomplicated UTI, less than 25% received empirical treatment as suggested. Urine culture and sensitivity analyses were performed frequently, even in patients who already had positive results on a urine dip-stick analysis. Although SMX-TMP is effective, it is underused. On the basis of these findings, we hope to provide interventions to increase SMX-TMP prescription, decrease use of urine culture and sensitivity analyses, and increase the frequency of 3-day antibiotic treatments at our institution.

UR - http://www.scopus.com/inward/record.url?scp=33846697618&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846697618&partnerID=8YFLogxK

U2 - 10.4065/82.2.181

DO - 10.4065/82.2.181

M3 - Article

C2 - 17290725

AN - SCOPUS:33846697618

VL - 82

SP - 181

EP - 185

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 2

ER -